Anthony Losquadro makes for a gallant chauffeur, though the vehicle he’s driving is a 30-foot-long, 9,000-pound repurposed van tricked out with a sound system, special lighting, and LED text signs. We’re in Washington, D.C. for the annual conference of the American Congress of Obstetricians and Gynecologists: he, to protest and me, to watch him.

For the past two years, Losquadro’s anti-circumcision group, Intaction, has used this eye-catching truck to highlight their cause. The images plastered to the tall, flat sides of Intaction’s mobile education unit are portraits of young men of various races, holding baby pictures while looking aggrieved. Those LED text signs scroll through messages like “Hygiene is about soap and water, not CUTTING,” and “Circumcision is painful and risky for babies.” I DID NOT CONSENT is emblazoned above and below, with Intaction’s name and website.

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“We encounter a lot of curiosity,” Losquadro tells me. “The majority of the response is positive.” I watch a man inside a sedan next to us tilt his head to read the truck’s sides. He makes a “hmm!” expression, nods in concession, and finally grabs his phone to take a picture.

A former merchant marine, Losquadro is square-jawed, dark-haired, and burly—the type of Italian New Yorker made famous by early Scorsese films. It was he who found the volunteer models and arranged a photo shoot, but it was Intact America, another anti-cutting group, who started the “I Did Not Consent” campaign in 2012 by inviting circumcised men to send shots of themselves in this same pose. (“Intact” is the anti-circumcision movement’s preferred descriptor for uncircumcised men.) Those opposed to infant penile circumcision often emphasize the harm it can cause while refuting its alleged medical benefits. But according to Losquadro, the most irrefutable argument is the one that hinges on personal rights.

“You can’t force a medical procedure on someone, no matter how beneficial it is,” he says, using the example of a cancer patient who forgoes chemotherapy. “How can you not sympathize with this position?” Even though we usually defer to legal guardians about what happens to the bodies of children—whether that involves dietary choices and medical treatments or even ear piercings—the intactivists find elective genital surgery particularly indefensible since it involves such an intimate part of the body.

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Most Americans are loath to consider the ethical implications of male circumcision given many men’s apparent apathy about their own. If it’s not usually a problem for those who’ve been through it, what’s the big deal? But Americans also claim to staunchly support independence and free will, whether that means freedom from the desires of the state or another individual, and bodily integrity is a crucial part of that. At a time when debates about campus assault, the sentencing of convicted rapists, and the alleged sexual crimes of Bill Cosby and Roger Ailes dominate mainstream news, Americans are becoming more fluent in the language of consent. So why shouldn’t it apply to babies and their penises?

Though their tactics can be inflammatory and sometimes rely on troubling, unexamined analogies, the anti-circumcision advocates have a point: America’s embrace of male circumcision, established in an era deeply hostile to sexuality, uniquely lays bare our gendered double standards about bodies, physical pleasure, and trauma.

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When we pull up to the convention center corner where other “intactivists” are spreading the message on foot, Losquadro receives a hero’s welcome: waves, shouts of greeting, rainbow flags and sturdy signs. Intactivism isn’t only for cis men. Plenty of women are in attendance, too, in a crowd of about 40 people that spans an age range of about 45 years. As Losquadro makes one more loop around before finding a parking space, I have the sense that I’m in a parade float, like a pageant winner. “Born in the USA” plays through the truck’s speakers. It’s a beautiful May morning in the nation’s capital. I text my friends: I’ve never felt so American.

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Compared to most of the world, the United States is big on circumcisions. At this point, it’s a secular American practice; it’s an obstetrician, not a religious figure like a mohel, who’s most likely to perform one. The U.S. circumcision rate (meaning how many newborns undergo the procedure) is officially placed at around 56%, which is lower than it once was but still far higher than other parts of the world. One-fourth of the planet’s men are Muslim and many are circumcised for religious reasons, as are most Jews, but the majority of European, Asian, and Central and South American countries don’t practice ritual foreskin removal, and the World Health Organization estimates only 30% of all men are circumcised.

Even fewer countries practice female circumcision, more commonly known as female genital mutilation and largely regarded as a serious human rights violation. (About 5% of the world’s women are circumcised, or 200 million of 3.7 billion.) In many parts of the world, it’s long been accepted that infant circumcision is unnecessary and devoid of substantial physical benefit.

Some countries have even banned it outright. In Denmark and Sweden, circumcisions that aren’t medically necessary are not allowed on children under the age of 12. Germany came close to an effective ban after a high court’s condemnatory ruling, but Parliament rushed to protect it in response to Muslim and Jewish outcry. In the 1970s, our own American Academy of Pediatrics agreed, “there are no valid medical indications for routine circumcisions, and the procedure cannot be considered an essential component of health care.” The Academy’s 2012 policy walked back this claim, stating “the health benefits of newborn male circumcision outweigh the risks,” but still stopped short of recommendation.

The politics of male circumcision first caught my attention in 2007, when the WHO officially recommended the procedure for Africans of all ages as an “important strategy” for HIV prevention in heterosexual men. For years, Washington D.C.—where I lived at the time—has struggled with an HIV epidemic that rivals rates of contraction in some African countries, and the United States’ HIV contraction rate overall has long outpaced other developed nations, countries in which circumcision is far less common. If circumcision were such a magic bullet for African states, why hadn’t it worked better here at home? I thought. And if it’s so effective, why wasn’t the recommendation that males everywhere be circumcised? The implicit argument seemed to be that it was easier to convince African men to sever a piece of their genitals than it was to convince them to use condoms—either that, or parts of Africa were to be the test region for a prescription not yet applied to the Western world. It had the hallmarks of colonialmentality run rampant.

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Circumcision is still not regarded as a viable HIV deterrent on any other continent. Even South Africa has rejected circumcision as a way to prevent HIV, and has prohibitions in place on circumcisions performed on boys under 16. Yet circumcision continues to be touted by many American doctors as a “surgical vaccine”—an inflated claim so widely criticized and so breathtakingly irresponsible it’s a wonder it’s still repeated. “Surgical vaccine” is not an actual thing, and the only time the phrase is ever used is in connection with HIV and male circumcision, in spite of the fact that condoms and anti-retroviral drugs are far, far more effective. (Why not rebrand condoms as a “wearable vaccine”?)

Anti-circumcision activists have to push back against a more-than-century-long ugly history.

All of this matters for any society invested in scientific accuracy, but it also matters for intactivists’ mission of winning hearts and minds. (None of the people I spoke with attacked religious beliefs, or prioritized passage of laws banning the act. A cultural shift was the goal.) When male circumcision is stripped of its patina of medical legitimacy, it becomes an ethically suspect procedure, at least when it’s performed on infants or children too young to give meaningful medical consent. Without health advantages, a parent’s decision to cut their child’s penis starts to seem capricious and indefensible.

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That’s exactly why some circumcision advocates grasp at straws to portray it as an easy, health-improving package—not just a surgical vaccine but a surgical multivitamin. In addition to the HIV angle, they cite lower rates of HPV contraction (although there’s a real vaccine for that) and lower incidence of urinary tract infections, which already has a low rate of occurrence among men.

The real pro-circumcision clincher, though, is the locker room argument—the claim that cutting is necessary because it’s already the norm, and without undergoing it, other boys will make fun. But parents regularly bestow children with names that invite ridicule. Bullies are merciless about a host of physical traits, from big ears to red hair, but parents don’t habitually dye their kids’ hair or interfere with their baby’s ears as a teasing preempting measure. And if Garfield is a traditional family name that’s been passed down for generations, you better suck it up, Garf, Jr.

Such distinctions can work in reverse, too. I went to high school with a boy who propositioned girls by promising his natural penis was more interesting, responsive, and special than circumcised ones. In gay communities, uncut men are often explicitly fetishized and if you’re looking for testimonials from women who love foreskin, you will find them. Fear of mockery is especially unfounded now that half of American babies do not get circumcised. Intactivists believe a more accurate count would put that number even lower, and that regardless of what it is now, it will continue to fall in the years ahead.

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Circumcision rationalizations, and the stigma they depend upon—that foreskins are dirty, hard to clean, and therefore teeming with bacteria—make sense in the context of America’s circumcision history. Foreskin removal became popular during the Victorian era, when an obsession with eradicating germs and masturbation took hold. Circumcision was recommended as prophylactic for a variety of health issues, especially “sexual problems,” and various medical professionals of the age remarked approvingly on the potential of creating a link between genitals and pain. (Use of anesthesia has only very recently become the standard, following an inexplicably protracted debate about whether babies actually felt pain during the procedure.) Nowadays we don’t often fret that foreskin is too perfect a masturbation sleeve, but the old chestnut that foreskins are filthy disease traps has held its ground.

“This is a lifetime wound. This is a permanent injury made visible.” — Brother K, anti-circumcision activist

Today, it’s the defenders of those supposed health benefits who often frame aversion to circumcision in Asian, Latino, and black parents as an issue of ignorance instead of cultural differences. Disconcerted by news of falling circumcision rates, which some experts attributed to the United States’ increasingly diverse demographics, the authors of one 2014 article suggested that the procedure be treated, once again, like vaccination and “be part of public health policies.”

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This legislative rhetoric has solid historical precedence, too. In the 1890s, several American physicians “vigorously advocated” for compulsory circumcision of black men to keep them from raping white women: The government should be “enforcing circumcision” as one would “vaccination or quarantine regulations.” (This suggestion was endorsed by at least two medical journals on the theory that Jewish men never rape, and their lack of foreskin must be the reason why—presumably because it was thought to decreases both genital pleasure and sexual craving.)

In the early 1900s, a doctor writing in the Journal of American Medical Association bemoaned the challenges of convincing syphilitic black men not to have sex, and suggested infant circumcision as the best method to control the spread of disease. As recently as 1949, doctors pointed to promiscuity, “meager” education, and a low circumcision rate to explain STIs among black citizens. Today, there are still doctors who maintain circumcision keeps Jewish men from committing rape.

Anti-circumcision activists have to push back against our more-than-century-long inculcation of this ugly history, along with a complacent modern medical community and deeply ingrained public misconceptions. So it’s no wonder they sometimes resort to dramatic, eyebrow-raising tactics to get their points across.

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One thing that hardly tempers intactivists’ reputation as a group of isolated crazies is their fondness for blood imagery. On that day in D.C., fake blood is everywhere. As Losquadro and I take another pass by the protesters, I spot one man leaning over to spray paint another’s crotch deeper red. They’re both wearing white jumpsuits, the better to make the “blood” stand out.

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Brother K is the man most prominently associated with the red-crotch-on-a-white-body look of some intactivism protesters. (Women wear the suits, too.) He’s head of the non-profit group Bloodstained Men, and he came by his name in 1986 when he changed it as a way to heal himself from the lasting psychic effects of circumcision. During a phone call after the protest, he would tell me that the “K” stands for “kind,” which I found easy to believe. He struck me as a deeply sincere and thoughtful guy in spite of his predilection for inflammatory visuals. “This is a lifetime wound,” he says. “This is a permanent injury made visible.”

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Brother K realizes the outfits “enrage some people,” but that’s part of what he’s going for. “Of course bloodstained suits generate an emotional response! We’re the shock troops of the movement.” He’s pleased when passersby take pictures and share them on social media, even as a form of ridicule, because a conversation is often sparked in the comments: At least the word is getting out.

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It’s hard not to make a parallel between intactivists’ gory tactics and anti-choicers’. While I’m with Losquadro, a gruesome anti-abortion van follows a similar route to ours. Its images of choice are mangled fetuses; its words concern Jesus, Planned Parenthood, the government. “This guy…” Losquadro says. “He’s really fringe.” But as I exit his truck to get lunch, something catches my eye: It was a mounted, life-sized diorama of a baby strapped to a circumcision board, with forceps and scalpel poised over its penis.

I’m not the only one who made connections with the anti-circumcision movement to unsavory rightwing extremists. When I speak to friends about anti-circumcision activists, they sometimes respond as if I were discussing men’s rights activists: I get eye rolls and derisive laughter. The implication is that intactivists are just whiny men seizing upon a flimsy excuse to feel oppressed. I was relieved, but not surprised to find the people I spoke to didn’t fit that stereotype, not least because many of them are women. (MRAs, of course, sometimes blame feminism for circumcision.)

There’s nothing wrong with (or unusual about) one group of protesters borrowing from the other. And there will always be extremists in every movement. Still, it’s hard to explain away some of intactivism’s common tonal missteps. Most intactivists are white, which makes sense since white families are the ones most likely to practice circumcision in the U.S. But it facilitates the regrettable lack of perspective that allows activists to suggest they’re participating in the equivalent of the 1960s civil rights, or to analogize a mother fighting to keep her son intact to Rosa Parks. And given the penchant for “consent” language, it’s not surprising that many intactivists compare circumcision to rape, often in crude and upsetting terms—including calling doctors rapists or “sex criminals.” (Losquadro had Nirvana’s “Rape Me” on his protest playlist.)

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Visceral provocations like the baby diorama seem unfair and inaccurate in a different way; as pro-choice advocates often point out, surgeries always involve blood. It’s true that in hospitals the baby is literally tied to a “circumcision board,” a phrase that wrenchingly evokes brutality. But babies sometimes have to be restrained for other, necessary procedures, too.

Instead of focusing on blood alone, it’s confronting the cosmetic purpose of male circumcision that forces nuanced ethical issues to come to the fore. “It’s not an exact science,” says one doctor describing the operation on video. “Sometimes we take too much [skin] or too little. The worst,” he adds, “is too little.” Because then the parents request the surgery be done again. There can be no doubt that in these situations, cutting is a culturally-mandated cosmetic choice, not a medically-driven one. But that distinction doesn’t come across when all you’re visually confronted with is a bloody crotch, or a baby’s penis underneath a scalpel.

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Yet even without Intaction’s diorama and Brother K’s suits, it’s the suggestion of fragility in a male body that would (and does) alarm and rankle. Given the way most of us think about cis male bodies and sexuality, a message of male genital vulnerability is likely to be received as extreme and lacking perspective no matter what. Intactivists demand serious protection of bodily integrity in a culture that doesn’t value it, not for women nor for men, nor, as some intactivists point out, for intersex people. (If only attention to the spectrum of invasive, status quo-establishing medical acts were as common as their predilection for overeager use of “rape.”) Feminism, queer theory, and other progressive scholarship has at least laid a groundwork for women to talk about their genital and sexual violations within a patriarchy. But men have not yet done the same for their own specific challenges.

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Nobody knows this better than Intact America’s Georganne Chapin, who meets me inside the convention center’s capacious lobby near a Starbucks. Unlike some of the protesters, she wears normal street clothes—no message tee, no bloody pants—but there’s no mistaking her focus. She’s pleasant and candid with me while we speak, but maintains the capable, brisk energy of a woman on a mission. “It’s a terror to confront what we’ve done to our boys,” she says.

Chapin sees circumcisions as part of a larger tendency towards indifference and denial of male pain. She mentions a recent Dear Abby letter in which a man writes in about his anguish and anger regarding his circumcision as an infant. Abby curtly tells him he needs psychological help because he’s probably displacing his reaction to a sexual assault—an example of our culture’s tendency to tell men, “it’s not the end of the world, get over it,” and a response Chapin finds to be woefully callous. We expect men to be so impervious to trauma that only large-scale horrors, namely combat in war, can harm them. (And even then, they may be regarded as wimpy or emasculated.)

Intactivists are treated as practically hysterical when they talk about male circumcision as mutilation but it’s not always a dramatic misnomer; sometimes circumcisions are botched. One study of Canadian doctors concluded that “most physicians performing neonatal circumcisions in our community have received informal and unstructured training.” A credentialed, practicing American pediatric urologist made a point of publicly confirming that he sees the effects of that educational oversight in the many corrective surgeries he performs, none of which are for cosmetic reasons alone. (Which means the effects are severe enough that penile function is impaired.) To deny and ignore the acute shame some men must feel, knowing they’ve been permanently injured in a culture of toxic masculinity that holds a penis to be a man’s defining characteristic, seems indefensibly cruel and senseless. A group of European physicians from 16 different countries unequivocally stated as much, in response to the American Academy of Pediatrics’ 2012 policy suggesting the health benefits of circumcision:

There are no compelling health arguments in favor of circumcision, while it can have serious long-term urological, psychological and sexual consequences. And performing medically unwarranted circumcision of underage boys conflicts with good medical practice. Male infant circumcision conflicts with children’s rights and the doctors’ oath not to do harm.

I don’t learn it until the day of the protest, but 34-year-old West Coast intactivist Jonathan Conte killed himself just days before the ACOG conference. His Facebook page is headed by the same sensationalism of the movement that gives some people pause: images of bloody babies paired with the imagined words of a villainous rapist. “Just relax, I know you’ll like it.” “You deserve it.” “It won’t hurt long.” Yet by all accounts of those who knew him, he was sensitive, intelligent, and gentle. Like the Dear Abby letter writer, Jonathan felt depressed, incomplete, and confused that his parents allowed him to be circumcised. “I didn’t have anybody to talk about this with,” he says in a video still online. “I felt isolated. I didn’t know how to deal with it.”

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Of Conte’s passing, Brother K wrote, “All of us see on a daily basis the frantic denial of our friends and relatives, the denial that circumcision has any meaning or significance in our lives.”

It makes sense that Conte borrowed the language of rape to express his pain; men don’t have any other models for discussing intimate forms of physical violation. And this type of social desertion is doubly poignant when considering how cold our culture is to male victims of actual rape. Chapin knows no one can definitively say why Conte killed himself. Still, she points out, “we would have no problem believing … a woman’s trauma [from circumcision] was valid. But we really resist hearing this from men.”

If they learn to speak the language of mainstream politics, the intactivists’ most profound contribution may be breaking down this gendered double standard, along with providing some necessary validation to men who are genuinely hurting. Chapin recalls conversations she had with circumcised men who’d met Losquadro or heard Jonathon Conte speak. “They were just overwhelmed with grief and gratitude that someone was talking about this,” she says. “The isolation is awful.”

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Charlotte Shane has written for Matter, Pacific Standard, The Verge, and is the author of Prostitute Laundry.